Home based PR vs Centre based PR

Good afternoon,  My name is Julie Pentony.​

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Welcome to my presentation about the research process which ​

will aim to demonstrate the following learning outcomes.​

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Searching for relevant research,  how it can impact on my practice and any ethical considerations.

First, a brief overview of evidence based practice.

​Sackett et al. (1996) describe it as a combination of these three elements for making decisions about patient care.​

(Click mouse)

This is Helen Aveyards definition, as practitioners we question our practice and  ​look for the best evidence to deliver care.

Therefore my question is........ (go to slide 3)

Now you may be wondering what is pulmonary rehabilitation?​

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Here is a definition from NICE, in brief it is an exercise and education programme ​for people with chronic lung diseases​

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Spruit et al. 2013 explain the benefits of PR. It improves exercise capacity and quality of life and reduces breathlessness and depression.

According to NICE  PR is an essential component  management of COPD.​

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Hogg et al. 2012  discuss poor attendance rates for centre-based PR and barriers for attending such as lack of motivation to attend, transport issues and timing of the exercise classses. 

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Within my practice area PR is mainly centre-based. ​

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Home based PR would address the majority of identified barriers  but would it provide ​the same benefits to patients as centre based PR?

Discussed by H Aveyard,  PICO tool is mainly used for quantitative research in health and social care to formulate a research question. ​

​Also according to Helen, if your question is asking if one treatment is better than another,  then RCTs are gold standard evidence in quantitative research.​

​Tricia Greenhalgh states that in EBP some forms of evidence are stronger than others for answering  a specific question.  

(Click mouse​)

This is an example of her hierarchy of evidence pyramid and as you can see RCTs are high up on the hierarchy.​

​For these reasons when looking for evidence to answer my question I decided to search for RCTs, using these terms in my PICO tool.

I conducted a literature search in 2 different databases Medline and Pubmed. I did search CINAHL first  (explain).

I used the specific words in my PICO tool for an advanced search, including the Boolean operators AND and OR. and limiters highlighted by Stella Cottrell​ in Study Skills handbook. 

 ​​Read the flowchart for each.​

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Finally I scanned the titles and the abstracts of  all nine papers in each database ​based on my question criteria to narrow it down to two.​

These are the two final papers which answered my question which are both quantitative studies. 

​Paper 1 is a RC prospective study, watching for outcomes and risks. Participants randomly selected into 3 groups.  Control (no treatment). Discuss findings.  ​

​Paper 2 is a RC equiv trial, assess equivalence in home based and centre based PR, rule out superiority or inferiority. Randomly selected participants 2 groups, discuss findings. ​

​According to Trisha Greenhalgh,  the CONSORT checklist is a tool used to assess the validity and quality of RCTs. I will use it in my essay to critically appraise these two papers.

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Ethical considerations to research. (read first line)​

​Research committees assess if research conforms to ethical standards and principles to protect participants.  

Both of my final papers gained approval from different ethics committees.

​Paper 1:  all  participants  agreed to participate, gave their informed consent and were permitted to leave at any time with no negative consequences. ​

​Paper 2: written informed consent was obtained, but does not go into any further detail. 

Yes HB PR is as effective as CB. It will improve attendance rates and access for pts, (pt preference) is one of the elements of EBP.  Both studies claim that HB PR is cost effective. 

However, both studies not conducted in UK, therefore not certain if results are representative of pts in my locality. 

NICE obtain evidence from systematic reviews, highest forms of evidence. Unable to find any, struggled to find much research to answer my question. Sample sizes small in each study and reduced further with pt drop outs. Therefore my so what is that further evidence is needed. 

However I will show these 2 papers to my line manager to discuss the possiblity of HB PR, he has the clinical expertise in PR and is the third element of EBP. However there may be issues with resources to implement it, only a small team. ​

Thank you for listening to my presentation on the research process.

Any questions?